title: Does adenosine response predict clinical recurrence of atrial fibrillation after pulmonary vein isolation?
abstract: BACKGROUND
  Approximately 30% of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF) have clinical recurrence of AF, and a great majority of these patients have recovery of vein conduction. Adenosine can be associated with acute recovery of conduction to the pulmonary veins immediately after isolation. However, it is not known whether this is prognostic for permanent recovery of conduction or recurrence of AF.
  
  
  METHODS
  Patients with paroxysmal AF underwent PVI, with administration of adenosine after electrical isolation. Those with transient conduction recovery (TCR+) underwent no further ablation and were compared to those without (TCR-) for clinical AF recurrence and conduction recovery at second procedure.
  
  
  RESULTS
  Seventy-two consecutive PVI patients were studied (mean age 56.7 ± 9.2, 61 male). Twenty-five (35%) patients had transient recovery of conduction with adenosine. After 1 year, 18 patients (25%) had symptomatic recurrence of AF. In this group of 18 patients, 6 were TCR+ at initial ablation (sensitivity 33%, NPV = 74%). In the remaining group of 54 patients free from AF recurrence, 35 patients (65%) were TCR- at initial ablation (specificity 65%, PPV = 24%). All 18 patients with recurrent AF underwent repeat procedure and had at least 1 pulmonary vein with recurrent conduction. The initial adenosine test correctly predicted 13 out of 36 (36%) veins, with positive predictive value 90% and negative predictive value 15%.
  
  
  CONCLUSIONS
  Adenosine testing for TCR does not appear to predict recurrence of clinical AF. TCR- veins remain susceptible to conduction recovery, as determined at the follow-up procedure.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
authors.forename: David
authors.initials: D
authors.lastname: Massel
authors.forename: Peter
authors.initials: P
authors.lastname: Leong-Sit
authors.forename: Christopher
authors.initials: C
authors.lastname: Gray
authors.forename: David J
authors.initials: DJ
authors.lastname: Fox
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.forename: Raymond
authors.initials: R
authors.lastname: Yee
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.forename: Allan C
authors.initials: AC
authors.lastname: Skanes
mesh_terms: D000241:Adenosine; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000502:physiology; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000241:Adenosine